Our baby daughter is breast-fed, but sometimes it would be convenient to supplement with a bottle of formula (mostly so that the mother can sleep a little longer while dad takes care of it).

We keep hearing/reading of the danger of "nipple confusion": that she will then no longer wish to breast feed as she will prefer the bottle.

Personally, I feel a bit doubtful that this could be a big problem. I tried googling for reputable literature on this, but could not really find any scientific studies on whether this is a real effect.

Is nipple confusion real? Can a bottle feeding once or twice a week trigger it?

4 Answers
4

When our son was born, he had jaundice, so the doctors had us feed him some formula through a syringe for the first 2 days to lower the bilirubin levels.

Our son started sucking on the syringe, despite our best efforts to avoid this. As a result, he became extremely frustrated while attempting to breastfeed, as the milk was not coming fast enough for him. We had to use rubber nipples with pumped breastmilk after that, as he would simply go limp and give up within moments of latching on to the real nipple, because it was too much effort, and he was used to how fast the rubber nipples gave milk.

To this day, if the nipple gets clogged, our son tends to pitch a fit (the only time he ever complains about anything is when he is hungry).

The lactation consultants we spoke with, as well as several books we read, indicated that artificial nipples should be avoided in the first 4 weeks. However, after the 4 week mark, infants are usually comfortable enough with a real nipple that nipple confusion is rarely an issue.

It is also worth noting that whether nipple confusion affects any given child is largely related to that child's temperment. There's a pretty wide variety of attitudes newborns have towards feeding, from very aggressive, to reluctant, as well as different levels of persistence. A child who aggressively nurses, even when his mother is waiting for her milk to come in, is probably much less likely to suffer from nipple confusion than some other children.

Oh yes, we had a very similar experience with our first son. He didn't actually take to breastfeeding until he was 4 months old, and that was only because my wife was exceptionally determined. She pumped for the whole time, feeding him with a bottle. It was absolute hell (imagine having to do this for the third time in the wee hours of the morning).
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ErnieMay 31 '11 at 20:10

Wow...we had bilirubin problems with both kids but all we got was UV treatment we never got told to change any feedings.
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MichaelFJul 21 '11 at 11:53

@MichaelF Admittedly, it has been close to a year, but I believe that UV treatment was the next step for us. The suggested increase in feedings was because his bilirubin levels were elevated, but low enough that they were hopeful that sufficient feeding would allow my son to excrete it naturally, so that they could avoid further treatments. It worked, although just barely. They gave him 2-3 days for his levels to drop before they were going to start UV, and, iirc, his levels dropped the day of the deadline.
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BeofettJul 21 '11 at 12:00

Bottle nipples feel different, and formula milk tastes different, so it's certainly plausible that a child might 'switch allegiance'. I believe I've also heard that drinking from a bottle is 'less work' for the baby, which might make them more fussy about hooking up to Mum's supply.

If the majority of feedings are nursing, you should be able to tell if you're starting to have any issues with nursing and adjust the bottles. You can decrease the bottle feedings if you have nursing issues, and change the bottle.

As for the actual difference, there's the milk vs formula taste, flow of liquid, temperature, and shape of the nipple.

Taste: If you used pumped breast milk, the taste would be the same as the fresh stuff.
Flow of liquid: There are bottle nipples that are shaped more like a breast
Temperature: My preferred way is to use hot tap water in a glass, submerging the bottle of milk. It takes a few minutes to warm, but you can shake the bottle to warm it faster.
Shape: There are different bottle nipples for different ages--a smaller flow (size of hole) for smaller babies, and a larger flow for older babies.

You can adjust quite a few of these factors in giving a bottle, which can make the experience similar to nursing.

Also, in the book Be Prepared, by Gary Greenberg and Jeannie Hayden, they mention bottle feeding being a way for the non-nursing partner to have a chance to bond in that very special, life-sustaining part of the baby's life.

Nipple confusion (also known as nipple preference) is very real. It can go either way, first baby was bottle fed almost from birth, and definately preferred the flow of the bottle compared with the 'effort' needed with a breast. (No matter how 'real to life' a bottle is, fact is milk will always drip out weather baby sucks or not, not so during the duration of breastfeeding - though during letdowns milk can actually spray out of the breast). My second child would not take a bottle if her life depended on it. (Okay, maybe if her life really depended on it, but it never got that far!)

I've excerpted a line about nipple confusion below from the above link;

There is no such thing as nipple confusion. Not true! The baby is not confused, though, the baby knows exactly what he wants. A baby who is getting slow flow from the breast and then gets rapid flow from a bottle will figure that one out pretty quickly. A baby who has had only the breast for three or four months is unlikely to take the bottle. Some babies prefer the right or left breast to the other. Bottle fed babies often prefer one artificial nipple to another. So there is such a thing as preferring one nipple to another. The only question is how quickly it can occur. Given the right set of circumstances, the preference can occur after one or two bottles. The baby having difficulties latching on may never have had an artificial nipple, but the introduction of an artificial nipple rarely improves the situation, and often makes it much worse. Note that many who say there is no such thing as nipple confusion also advise the mother to start a bottle early so that the baby will not refuse it.

Because it is real however, doesn't mean it will definately happen to your baby, but it may, even with only one bottle per week. It's an issue of deciding if this possible problem is big enough to worry about, or if the one bottle a week is worth it knowing this possible problem does exist.